In Latin America and the Caribbean, public laboratories that produce vaccines have contributed in varying degrees to the control and eradication of vaccine-preventable diseases, and several of them are manufacturing vaccines that are routinely applied in national immunization programs, such as the vaccine against tuberculosis (made with the bacillus of Calmette-Guérin, BCG), the triple vaccine against diphtheria-tetanus-pertussis (DTP), tetanus toxoid (TT), the vaccine against measles and the oral vaccine against polio. Thanks to recent scientific strides, one can foresee an important increase in the number of safe and effective vaccines that will be available in the near future for use in routine vaccination programs. However, there are high costs involved in developing such vaccines and in protecting the intellectual property rights involved, and few laboratories in Latin America have the technical capacity to research and develop these vaccines. Such factors will affect the speed with which they are assimilated into vaccination programs in countries of the Region. Currently, public laboratories that manufacture vaccines in the Region are not equipped to compete in this new scenario and run the risk of being completely outmarketed. Thus, they must radically change their style of management and their scientific and technical capabilities, backed by a commitment from governments to improve and strengthen those political and financial aspects that can assure that national laboratories participate in the sustainable supply of vaccines to immunization programs, as well as in researching, developing, and producing new vaccines.

Stroke in Trinidad and Tobago: burden of illness and risk factors Articles

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29%. Among surviving patients, 437 (56%) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35_64 years were 114 (95%CI: 83 to 145) per 100 000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 to 186). Among patients with first strokes, 348/531 (66%) reported physician-diagnosed hypertension, but only 226 (65%) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.

It has been shown that people of all ages can benefit from the topical and systemic effects of water fluoridation. However, the increase in consumption of bottled water, either to substitute for or supplement consumption of water from public sources, has implications for safe fluoride supplementation. Taking that into consideration, in 1995 we analyzed the fluoride content in 31 commercial brands of mineral water in the region of Araraquara, state of São Paulo, Brazil. Fluoride concentration as determined by our analysis was compared to the concentration of fluoride specified on each label. Only 25% of the products studied listed the fluoride concentration on their labels. In addition, among 31 mineral water brands, 26 listed the date when the chemical analysis to determine chemical composition had been performed. Of these, 20 had not been put through the annual chemical analysis determined by Brazilian law. Based on these results, if the mineral waters tested had been the only source of drinking water, fluoride supplementation would have been necessary in 69% of the samples analyzed. In the case of children up to 6 years of age who use products containing fluoride, such as topical gels, mouthwashes or toothpastes, supplementation should be recommended only if commercially bottled water is the only source of water used, not only for drinking but for cooking as well.

Spatial distribution of insecticide resistance in Caribbean populations of Aedes aegypti and its significance Articles

To monitor resistance to insecticides, bioassays were performed on 102 strains of the dengue vector Aedes aegypti (L.) from 16 countries ranging from Suriname in South America and through the chain of Caribbean Islands to the Bahamas, where the larvicide temephos and the adulticide malathion have been in use for 15 to 30 years. There was wide variation in the sensitivity to the larvicide in mosquito populations within and among countries. Mosquito strains in some countries such as Antigua, St. Lucia, and Tortola had consistently high resistance ratios (RR) to temephos, ranging from 5.3 to 17.7. In another group of countries-e.g., Anguilla and Curaçao-mosquitoes had mixed levels of resistance to temephos (RR = 2.5-10.6), and in a third group of countries, including St. Kitts, Barbados, Jamaica, and Suriname, mosquitoes had consistently low levels of resistance to temephos (RR = 1- 4.6) (P < 0.05). On occasion significantly different levels of resistance were recorded from neighboring A. aegypti communities, which suggests there is little genetic exchange among populations. The impact of larval resistance expressed itself as reduced efficacy of temephos to kill mosquitoes when strains were treated in the laboratory or in the field in large container environments with recommended dosages. Although a sensitive strain continued to be completely controlled for up to 7 weeks, the most resistant strains had 24% survival after the first week. By week 6, 60% to 75% of all resistant strains of larvae were surviving the larval period. Responses to malathion in adult A. aegypti varied from a sensitive population in Suriname (RR = 1.3) to resistant strains in St. Vincent (RR = 4.4), Dominica (RR = 4.2), and Trinidad (RR = 4.0); however, resistance was generally not on the scale of that observed to temephos in the larval stages and had increased only slightly when compared to the levels that existed 3 to 4 years ago. Suggestions are made for a pesticide usage policy for the Caribbean region, with modifications for individual countries. This would be formulated based on each country's insecticide-resistance profile. Use of physical and biological control strategies would play a more critical role than the use of insecticides.

This study aims to describe the measles vaccination campaigns that have been carried out in the state of Minas Gerais, Brazil, since 1988; to highlight their importance in the control of the disease, and to pinpoint the age groups at risk during the recent epidemic, which began in 1996, spread all over the country, and declined in 1998. However, the analysis includes only data up to September 1997. The methodology used was based on the birth cohort analysis design. Data compared by cohorts included target population and vaccination coverage for each campaign, and measles incidence rates during the present epidemic. Results show that the more opportunities for exposure to vaccination campaigns, the lesser the risk for having measles in any birth cohort. In 1997, the relative risk for getting measles was 15,38 (IC95%: 9,89 to 23,93) for the cohort under 2 years of age, which had not had the opportunity to be exposed to any vaccination campaigns, as compared to cohorts between 3 and 19 years of age with two or more opportunities of exposure to vaccination campaigns. On the basis of the experiences analyzed, catch-up measles vaccination campaigns as well as follow-up campaigns-particularly when routine vaccination did not achieve sufficient coverage-have had an outstanding role in controlling the measles epidemic in the state of Minas Gerais. We therefore suggest making the measles vaccine immediately available to all birth cohorts that did not have the opportunity for exposure to past vaccination campaigns and intensifying epidemiological surveillance. Moreover, it is necessary to find ways to improve routine vaccination coverage in order to achieve the 95% goal set by the National Plan to Eliminate Measles by the Year 2000.

In 1995, the WHO Global Programme for Vaccines and Immunization established a vaccine trial registry. As of September 1996, this registry included 50 WHO supported vaccine trials, of which 25 (50%) were completed studies. The vaccines most frequently tested have been against measles (9 trials), poliovirus (8 trials), cholera (8 trials), enterotoxigenic Escherichia coli (4 trials), and pneumococcus (4 trials). Nearly 80% of these trials have been conducted in developing countries, with the largest number being in Africa. Among the 25 completed trials, outcomes measured were immune response (24 trials), adverse reactions (13 trials), morbidity (4 trials), and mortality (1 trial). WHO's contributions to these studies include direct funding, assistance with study design, site visits, data analysis, vaccine procurement, and vaccine potency testing.

Retiros del mercado Información Farmacológica

Uso racional Información Farmacológica

In celebration of the World Health Organization's 50th anniversary, this article features WHO's contribution to the world by examining its current activities in the areas of health, human rights, and development. It briefly summarizes events leading to its establishment over the period from 1851 to 1948, which marks the year when WHO assumed its role as a specialized body of the United Nations. Quoting from various articles in WHO's Constitution, it illustrates the principles that prompt its actions and that have led nations to become aware of their potential goals, thus steering them toward a brighter future. A brief overview of the last 20 years ends with the introduction of WHO's new Director General, Dr. Gro Harlem Brundtland.

Atención primaria ambiental para el siglo XXI Temas de Actualidad

Primary environmental care combines the original strategy proclaimed at Alma-Ata as primary health care and the conception of integral rural development that emerged from the agrarian policies of Third World countries during the seventies. Within the renewed goal of health for all in the 21st century, the primary environmental care strategy may be considered as all those actions necessary to improve and protect the local surroundings through foresight and prevention of possible problems, with tasks institutionalized at the local level. Analysis and practice of this strategy are based on a model focused on the promotion of human beings, the environment, and social development. Furthermore, it is founded on critical theory and has a holistic perspective. This operational frame encourages participation and action, thus endowing individuals, communities, and societies with the power to make decisions. In this way, leadership is created for the sustainable development of nations.